The entire medication process |
1. Detection and referral to solve failures in the process are the responsibility of the nurse or nursing technician |
2. There is a lack of clarity in the chain of help to solve doubts |
Patient/Subjective and objective health information |
3. Shift handover time is reduced, making communications difficult |
4. Lack of privacy on the ward to collect information |
5. Language barrier to obtain information (idioms) |
6. Pain evaluation for patients with chronic analgesic use |
7. Data collection about allergies is not standardized |
8. Patient contact time is reduced |
24-hour prescription |
9. Patients without current prescriptions lead to delays in the medication process |
10. Lack of preparation and administration guidelines |
11. Lack of parameters on the prescription |
12. Different presentations for the same patient |
13. Conciliation, preparation and administration generate delay |
14. Routine installation of total parenteral nutrition solution is at night |
15. Divergence from internal protocols generates doubts |
Change of prescription |
16. Lack of communication of changes between doctor and nurse |
17. Excluded drugs are not returned |
18. Non-medical teams change prescription of nutritional support, with no change of the computerized medical prescription |
Medical prescription scheduling |
19. Lack of knowledge about interactions |
20. Rework on reprinting, updating and organizing the last prescription |
21. Not shown on the patient list making it necessary to access the prescription of each patient to check the completion of the task |
22. Item not scheduled, not flagged and not administered. |
Information about the preparation, administration and disposal of residuals |
23. Routines are up-to-date and care staff are unaware, require interpretation and calculations, and the routine consultation system is difficult to access. |
Preparation of medication/Release of medication by automated medication dispenser |
24. The released medicine is not identified immediately |
25. Bar code reader is difficult to handle with ineffective reading delaying the process |
26. Existence of expired medicine in the automated medication dispenser |
27. Lack of ergonomic organization of drugs by volume of use, validity, appearance or similar name |
28. Short login time, generates need to re-input user and password again |
29. Failure to replace saline solution as it is not required to register use |
Preparation of the drug/Search for the drug in the pharmacy |
30. Nursing technician needs to go away from the station to the dispensing pharmacy in search of medicines that are not in the automated medication dispenser |
Preparation of the drug |
31. Storage environment without temperature and humidity control |
32. Excessive movement of the team because of the distribution of materials and for waste disposal from the nursing station |
33. Interruptions in preparation environment does not allow concentration |
34. Preparation of the medicines for several patients causes delays |
35. Manual filling of medication identification labels |
36. Tray dividers do not allow proper organization. Trolley used for both medication and bathing |
Medication administration |
37. The patient's own medication administration is not supervised by the team |
38. Delayed administration in relation to the scheduled time |
39. Checking is a visual identification of drug and patient |
Recorded on patient chart |
40. Not done in real time. Manual check in two places |
41. Lack of computer availability |
42. Check is carried out at scheduled time and not at time of administration |
43. Information reported by the patient of the drug's action is not recorded in real time causing delay in clinical decision making |
44. Adverse reactions to drugs are rarely registered during evolution, causing difficulty for the pharmacist to trace them |
Patient |
45. Drugs are not received at the scheduled time due to delays in the process. |